May 23, 2019

Ten former Ontario health ministers from across the political spectrum are taking the rare step of sending a joint letter to the government, imploring it to reverse millions of dollars in public health cuts they say put the province "at risk."

The letter is being sent to Health Minister Christine Elliott on Thursday morning, and is signed by:

• Six former Liberal ministers: Dr. Helena Jaczek, Dr. Eric Hoskins, who served in the Kathleen Wynne government, former deputy premier Deb Matthews, and David Caplan, Elinor Caplan and George Smitherman.

"Traditionally, Ministers of Health have avoided commenting on the policies of their successors," it reads. "Health has been seen as a non-partisan issue — something we all support. This attack on public health has prompted us to break our silence."

The group is calling for a restoration of public health funding to keep water clean, prevent infectious disease, give vaccinations and provide school breakfast programs to children in need.

Concern mounts

Premier Doug Ford's government recently notified municipal public health units in phone calls that it will reduce its cost-sharing levels from 100 per cent or 75 per cent in some cases, to 60 to 70 per cent for some municipalities, and 50 per cent for Toronto. It says the cuts will save Ontario $200 million per year by 2021-2022.

The plans also include cutting the number of public health units in Ontario from 35 to 10.

"If the government wants to end hallway medicine, as you have pledged, one of the best ways to do that is to actually invest more, not less, in public health. We need only look back to the SARS epidemic to realize the devastating impact of failing to invest in public health," the letter says.

"Funding must be restored."

For Toronto, the cuts amount to $1 billion over the next decade, according to city board of health chair Joe Cressy, and mean an immediate $86-million hole in its latest budget. Mayor John Tory called the change a "targeted attack."

Firearm mortality is a leading, and largely avoidable, cause of death in the USA, Mexico, Brazil, and Colombia. We aimed to assess the changes over time and demographic determinants of firearm deaths in these four countries between 1990 and 2015.

Methods

In this comparative analysis of firearm mortality, we examined national vital statistics data from 1990–2015 from four publicly available data repositories in the USA, Mexico, Brazil, and Colombia. We extracted medically-certified deaths and underlying population denominators to calculate the age-specific and sex-specific firearm deaths and the risk of firearm mortality at the national and subnational level, by education for all four countries, and by race or ethnicity for the USA and Brazil. Analyses were stratified by intent (homicide, suicide, unintentional, or undetermined). We quantified avoidable mortality for each country using the lowest number of subnational age-specific and period-specific death rates.

Findings

Between 1990 and 2015, 106·3 million medically-certified deaths were recorded, including 2 472 000 firearm deaths, of which 851 000 occurred in the USA, 272 000 in Mexico, 855 000 in Brazil, and 494 000 in Colombia. Homicides accounted for most of the firearm deaths in Mexico (225 000 [82·7%]), Colombia (463 000 [93·8%]), and Brazil (766 000 [89·5%]). Suicide accounted for more than half of all firearm deaths in the USA (479 000 [56·3%]).

In each country, firearm mortality was highest among men aged 15–34 years, accounting for up to half of the total risk of death in that age group. During the study period, firearm mortality risks increased in Mexico and Brazil but decreased in the USA and Colombia, with marked national and subnational geographical variation. Young men with low educational attainment were at increased risk of firearm homicide in all four countries, and in the USA and Brazil, black and brown men, respectively, were at the highest risk.

The risk of firearm homicide was 14 times higher in black men in the USA aged 25–34 years with low educational attainment than comparably-educated white men (1·52% [99% CI 1·50–1·54] vs 0·11% [0·10–0·12]), and up to four times higher than in comparably-educated men in Brazil, Colombia, and Mexico.

In the USA, the risk of firearm homicide was more than 30 times higher in black men with post-secondary education than comparably educated white men.

If countries could achieve the same firearm mortality rates nationally as in their lowest-burden states, 1 777 800 firearm deaths at all ages and in both sexes could be avoided, including 1 028 000 deaths in men aged 15–34 years.

Interpretation

Firearm mortality in the USA, Mexico, Brazil, and Colombia is highest among young adult men, and is strongly associated with race and ethnicity, and low education levels. Reductions in firearm deaths would improve life expectancy, particularly for black men in the USA, and would reduce racial and educational disparities in mortality.

BACKGROUND: Household food insecurity, a measure of income-related problems of food access, is a pressing public health problem in Canada’s North, especially in Nunavut. We aimed to assess the impact of Nutrition North Canada, a food retail subsidy intended to improve food access and affordability in isolated communities, on household food insecurity in Nunavut.

METHODS: Using data from 3250 Nunavut households sampled in the annual components of the Canadian Community Health Survey (2007 to 2016), we conducted interrupted time series regression analyses to determine whether the introduction of Nutrition North Canada was associated with changes in the rates of self-reported food insecurity, according to a validated instrument. We used propensity score weighting to control for several sociodemographic characteristics associated with food insecurity.

RESULTS: Food insecurity affected 33.1% of households in 2010 (the year before the launch of Nutrition North Canada), 39.4% of households in 2011 (the year of the launch) and 46.6% of households in 2014 (the year after full implementation). After controlling for several covariates, we found the rate of food insecurity increased by 13.2 percentage points (95% confidence interval [CI] 1.7 to 24.7) after the full implementation of the subsidy program, and the increase in food insecurity first occurred in 2011 (9.6 percentage points, 95% CI 2.7 to 16.4), the year Nutrition North Canada was launched.

INTERPRETATION: Food insecurity was a pervasive problem in Nunavut before Nutrition North Canada, but it has become even more prevalent since the program was implemented. Given the important health consequences of food insecurity, more effective initiatives to address food insecurity in Canada’s North are urgently needed.

Household food insecurity, defined as insecure or inadequate access to food because of financial constraints, is increasingly recognized as a serious public health problem in many affluent nations. The latest national estimate for Canada indicates that 12.6% of households experienced food insecurity in 2012, but important geographic variations exist within the country, with heightened vulnerability in the North. Since national monitoring began, Nunavut has consistently had the highest rates of food insecurity, with the rate reaching 46.8% in 2014.

Food insecurity is strongly associated with poor nutrition and adverse mental and physical health outcomes across the life cycle. Recent research also indicates that food insecurity is a robust and independent predictor of increased health care use and expenditures. Food insecurity represents an experience of material deprivation strongly influenced by the economic resources of households, but high food prices are also considered an important driver of food insecurity in Canada’s North. In April 2011, the Government of Canada replaced the long-standing Food Mail Program with Nutrition North Canada, a market-driven food retail subsidy intended to make perishable, nutritious foods more affordable and accessible in northern communities that do not have year-round rail, road or marine access.

Similar to the Food Mail Program, Nutrition North Canada serves communities that are predominantly inhabited by Indigenous Peoples and have high rates of food insecurity, low educational attainment, low income, underemployment and unemployment.

Whereas the Food Mail Program consisted of an air freight transportation subsidy transferred to Canada Post for the delivery of numerous perishable foods, nonperishable foods and essential nonfood items, Nutrition North Canada is a retail subsidy focused primarily on perishable, nutritious foods and transferred directly to southern suppliers and northern retailers, who are expected to pass on the full subsidy to consumers at the point of purchase (a summary of the programs is provided in Appendix 1, Supplemental Table A1, available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.181617/-/DC1).

Nutrition North Canada follows a market-driven approach predicated on the assumption that giving full control to retailers and suppliers over the supply chain and relying on market competition can reduce the prices of subsidized foods more effectively. The program’s focus on perishable, nutritious foods and its market-driven approach were strategies adopted to help contain program costs. Nutrition North Canada also includes a small nutrition-education component, and it is assumed that reductions in the prices of perishable, nutritious foods coupled with nutrition education will improve northerners’ food access.

Although Nutrition North Canada does not explicitly aim to reduce food insecurity, the pervasiveness of food insecurity in the North is embedded in the rationale for the program.

Our objective was to assess the impact of the introduction of Nutrition North Canada on household food insecurity in Nunavut communities.

The research shows head-to-toe harm, from heart and lung disease to diabetes and dementia, and from liver problems and bladder cancer to brittle bones and damaged skin. Fertility, foetuses and children are also affected by toxic air, the review found.

The systemic damage is the result of pollutants causing inflammation that then floods through the body and ultrafine particles being carried around the body by the bloodstream.

Air pollution is a “public health emergency”, according to the World Health Organization, with more than 90% of the global population enduring toxic outdoor air. New analysis indicates 8.8m early deaths each year – double earlier estimates – making air pollution a bigger killer than tobacco smoking.

But the impact of different pollutants on many ailments remains to be established, suggesting well-known heart and lung damage is only “the tip of the iceberg”.

“Air pollution can harm acutely, as well as chronically, potentially affecting every organ in the body,” conclude the scientists from the Forum of International Respiratory Societies in the two review papers, published in the journal Chest. “Ultrafine particles pass through the [lungs], are readily picked up by cells, and carried via the bloodstream to expose virtually all cells in the body.”

Prof Dean Schraufnagel, at the University of Illinois at Chicago and who led the reviews, said: “I wouldn’t be surprised if almost every organ was affected. If something is missing [from the review] it is probably because there was no research yet.”

The review represents “very strong science”, said Dr Maria Neira, WHO director of public and environmental health: “It adds to the very heavy evidence we have already. There are more than 70,000 scientific papers to demonstrate that air pollution is affecting our health.”

She said she expected even more impacts of air pollution to be shown by future research: “Issues like Parkinson’s or autism, for which there is some evidence but maybe not the very strong linkages, that evidence is coming now.”

Lassa fever cases have increased in Nigeria since 2016 with the highest number, 633 cases, reported in 2018. From 1 January to 28 April 2019, 554 laboratory-confirmed cases including 124 deaths were reported in 21 states in Nigeria. A public health emergency was declared on 22 January by the Nigeria Centre for Disease Control.

We describe the various outbreak responses that have been implemented, including establishment of emergency thresholds and guidelines for case management.

May 05, 2019

4 May 2019, Bafia – With overwhelming grief and respect, Dr Richard Valery Mouzoko Kiboung, a devoted doctor, epidemiologist, husband and father who had worked with the World Health Organization (WHO) for the past five years was buried today in his native Cameroon.

Dr Mouzoko, 41, died from a gunshot wound sustained during an assailants’ attack on 19 April 2019 at Butembo University Hospital, where he was chairing a meeting with front-line health workers battling the Ebola virus disease in the North Kivu Province of the Democratic Republic of the Congo (DRC).

A man described as “ready to fly instantly to help his neighbour”, Dr Mouzoko was leading the WHO response team at the Butembo University Hospital’s Ebola treatment centre, in one of the worst Ebola hot spots in the country.

"The passing of Dr Richard is an enormous loss for WHO and the people of the DRC he was serving when his life was so brutally and senselessly taken away. It’s also an enormous loss for Cameroon, and most of all for his family, who have lost a husband, a father, a son and a brother,” WHO Director-General Dr Tedros Adhanom Ghebreyesus told hundreds of mourners.

“The world of public health and WHO, in particular, lost someone exceptional in that April attack,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “We enter this profession to help others live healthier lives. We expect long careers and hope to live to see some results of our work. Dr Richard had great impact in his short life and helped make countless lives healthier. He was a doctor, a humanitarian and a hero – an example for us all.”

In his career, Dr Mouzoko worked in areas with low vaccination coverage and contributed towards improving the health of vulnerable communities, like refugees, internally displaced persons and nomadic populations. He also investigated diseases like yellow fever, measles, polio, meningitis, neonatal tetanus and Ebola and organized vaccination campaigns against these diseases.

He spoke eight languages and touched people with a humanity that put others first. He trained hundreds of doctors and health workers to better help the vulnerable communities he cared about. Public health was his passion.

After graduating from medical school at the University of Yaoundé, Dr Mouzoko went on to pursue a master’s degree in public health at the Institute of Tropical Medicine in Antwerp, Belgium.

"Dr Richard made the ultimate sacrifice. But that sacrifice will not be in vain. It is thanks to people like him that we have made progress against Ebola, and it is thanks to people like him that the epidemic will be defeated,” said Dr Tedros.

Dr Mouzoko is survived by his wife, Friquette Tata, and his four children, Beleck Margaret, Moulong Simon, Wolimum Emmanuelle and Amewock Nathan.

Kyle Mullica, a freshman member of Colorado’s House, came into office this past January with a sense of mission.

An emergency-room nurse, he had run a campaign based on his experience in the world of medicine, in an era where anxiety about health care is high. Even with his experience, he was surprised when during an introductory meeting with an official from the state’s Department of Public Health and Environment, he was told that Colorado was at the bottom nationwide for the percentage of children in kindergarten who were vaccinated against diseases such as measles, mumps and rubella. He had seen people coming into the ER with “vaccine-preventable” diseases like whooping cough, he said, but he was still shocked.

“That was extremely concerning to me,” he said in a phone interview this week. “I wanted to make sure we were doing something about that.”

Mullica, a Democrat who represents a district in the Denver area, said he started looking at options to improve this. This week, a bill he sponsored to tighten vaccination protocols for parents raised hopes among public health groups. It died in the state Senate on Thursday afternoon.

But being the face of a political effort to tackle this pressing public health issue has made Mullica the target of threats. After the bill passed the state’s House on Saturday, Mullica received an email that likened him to a Nazi doctor and said that he deserved to die.

“The world would be better if your home burned down with you and your family in it,” it read in part, according to a copy published by CBS.

Mullica declined to comment further on the threat, saying that it had unsettled his family.

“I don’t want to be bullied and intimidated from doing what I believe in. What I believe is going to protect our community but there’s nothing I would ever do to put my family in harm’s way either,” he told CBS.

“I’ve had plenty of civil discussions with people who disagree with me on the issue, and we should. That’s how we make good policy. But leave my family out of it.”

The Colorado State Patrol said it was investigating the threat and declined to comment further. The Colorado bill comes amid growing concern about how widely anti-vaccination efforts are spreading around the country. More than 700 people have been sickened by measles this year, according to the Centers for Disease Control and Prevention — the largest number in 25 years. More than 500 of those infected were not vaccinated.

Vaccinations has become a hot topic of debate for state legislators around the country. In Washington, the state’s Senate passed a bill in April to eliminate personal and philosophical exemptions to vaccines after the state’s worst measles outbreak in two decades.

April 26, 2019

On the occasion of the commemoration of the 12th JMP 2019, the Minister of Public Health announced that the DRC has recorded more than 18 million cases of malaria in 2018, of which more than 16 million cases of simple malaria and 1.8 million cases of severe malaria. Of this number, 18 thousand people died.

Placed this year under the theme "Zero Malaria. I commit myself ", the 12th World Malaria Day (JMP 2019) was celebrated yesterday Thursday, April 25th by the international community. In Kinshasa, the Minister of Public Health and the actors of the fight against malaria met on the campus of the Academy of Fine Arts (ABA), in Kinshasa / Gombe, to commemorate and prepare the state of play against the scourge of malaria in the DRC. On this occasion, the Minister of Public Health declared that the celebration of this 12th JMP reminds the suffering conveyed by malaria with its cohort of expenses and deaths unacceptable, because avoidable.

Malaria, he said, is the leading cause of morbidity, hospitalization and mortality in the country. Thus, this pathology killed silently during the year 2018, more than 18 thousand people in the DRC on more than 18 million cases of malaria, including 16 million cases of simple malaria and more than 1.8 million severe malaria, or nearly 10%. These figures are staggering and must appeal to the national community.

It is therefore in this sense that we must inscribe the manifestation of the day that encourages awareness and urgent action. It is precisely because of the need to act against this pathology that the Government of the Republic has committed, through the Ministry of Health, to guarantee universal access to key interventions in the fight against malaria for all inhabitants. from the country.

April 25, 2019

ISLAMABAD — Two gunmen on motorcycle shot and killed a polio vaccinator in the southwestern Pakistani city of Chaman on Thursday, bringing the death toll among vaccinators working in the country’s anti-polio drive to at least three this week, officials said.

The shooters opened fire on a group of vaccinators when they were at the front gate of a house in the remote village of Sultan Zai, near the border with Afghanistan, said Samiullah Agha, who is the assistant commissioner of Chaman.

Two members of the vaccination team were hit: Nasreen Bibi, 35, was killed, and Rashida Afzal, 24, was critically wounded, Mr. Agha said in an interview. Vaccination was suspended for an indeterminate period of time in the Chaman area after the shooting.

“The gunmen fled after the attack,” Mr. Agha added. “Security forces have launched a search operation in the area.”

Polio vaccination teams have suffered several attacks since a countrywide vaccination drive began on April 23. Polio workers, volunteers and their guards are frequently targeted in the South Asian country. Islamist militants and hard-line clerics say the vaccination drive is a foreign plot to sterilize Muslim children and a cover for western spies.

“These are unfortunate incidents,” said Babar Atta, who is the special adviser on polio to Imran Khan, Pakistan’s prime minister. “We have increased the security of vaccination teams across the country and are determined to end this crippling disease in Pakistan.”

Hayat Khan, a resident of a tribal area bordering Afghanistan who runs a shop, said he is skeptical of the polio vaccine. Neither he nor his parents have taken the vaccine, which can be delivered orally as drops, and they are living a healthy life, he said.

“We have doubts in our minds about this western vaccine,” he said. “Tribal people are not sure what they are giving to our children and what information they are collecting for spying. It’s a Western agenda, indeed.”

Two days ago, in separate events, two police officers who were protecting polio vaccination teams were shot and killed in the northern districts of Buner and Bannu. And a polio worker was injured in a knife attack this week in the eastern city of Lahore.

When the Doug Ford government decided to cut funding to Ontario cities for public health, it must have expected local politicians to protest. What it might not have reckoned on is the soft-spoken grit of a civil servant.

Eileen de Villa, Toronto’s Medical Officer of Health, has emerged as a leading voice against the cuts, which have hit the country’s largest city as it is struggling with a wave of deaths from the opioid crisis.

The Progressive Conservative government announced just before the Easter long weekend that it was reducing public-health transfers to municipalities around the province. Toronto figures it will lose a billion dollars over 10 years. Dr. de Villa was one of the first to speak out, saying she was “extremely disappointed” and that the cuts would have “significant negative impacts” on the health of Toronto residents.

“Whether it is providing school immunization programs, protecting people from measles, influenza, the next SARS and other outbreaks, helping keep our water safe to drink, inspecting our restaurants, pools and beaches, investments in public health keep our city and residents safe, healthy and strong,” she said in a statement.

On Wednesday, after Health Minister Christine Elliott defended the cuts against what she called “fear-mongering” attacks, Dr. de Villa spoke out again – evenly and moderately. Flanked by several people who told stories about how public health had helped them during their struggles with illness, she told a City Hall news conference that investing in public-health services actually saves governments money by heading off costly disease and ill health.

It was the second time in a month that Dr. de Villa has objected to a decision by the government. After Mr. Ford’s government said it was cutting funding to some safe-injection sites around the province, including two in Toronto, she said “I expect you will see deaths. I don’t think that’s hyperbole, nor do I think that’s exaggeration. I think it’s calling the facts as they are.”